Constipation is noted in up to 87% of terminally ill pts. Medications that commonly contribute to constipation include opioids used to manage pain and dyspnea and tricyclic antidepressants with their anticholinergic effects. Inactivity, poor diet, and hypercalcemia may contribute. GI tract obstruction also may play a role in some settings.

Interventions Improved physical activity (if possible), adequate hydration; opioid effects can be antagonized by the µ-opioid receptor blocker methylnaltrexone (8-12 mg SC daily); rule out surgically correctable obstruction; laxatives and stool softeners (Table 9-2).